28 August 2009

Solution for Tennis Elbow!

...researchers from the Nicholas Institute of Sports Medicine and Athletic
Trauma at Lenox Hill Hospital in New York City announced last month
that they’ve developed an effective and supremely cheap treatment for
chronic tennis elbow. Huddling a while back to brainstorm about
inexpensive methods for combating the injury, the scientists glanced
around their offices and noticed a homely, low-tech rubber bar, about 8
inches long, which, at the time, was being used for general physical
therapy programs. The researchers wondered whether the ribbed, pliable
bars, available for less than $20, might be re-purposed to treat tennis
elbow. The answer, it soon become clear, was a resounding yes.

...in the past two or three years, doctors and researchers have begun
focusing on a particular kind of exercise that has shown promise
against other achy tendons, especially the Achilles. The program
involves eccentric exercises, which aren’t oddball moves but those in
which the muscle lengthens as it tenses. Think of a biceps curl. When
you raise the dumbbell, your bicep shortens and tightens. That’s a
concentric contraction. When you lower the weight, the muscle
lengthens, straining against the force of the weight. That’s eccentric.
...

“There’s a growing body of research showing that eccentric exercises
are quite effective in treating Achilles tendonosis” and other tendon
problems, Tyler says.

One of those studies was a well-designed 2007 experiment centered on
tennis elbow. Conducted in Belgium, it found that eccentric exercises
provided considerable relief. But the exercises had to be performed on
expensive machines under medical supervision during repeated office
visits. “We looked at those results and thought, there has to be an
easier, more cost-effective way,” Tyler says.

Which is how they arrived at the rubber bar technique. He and his
colleagues realized that a single, unhurried exercise using a tensile
bar that looks like an oversized licorice stick could create an
eccentric contraction all along the forearm. In the exercise, a person
holds the bar upright at his or her side using the hand connected to
the sore elbow, then grasps it near the top with the good hand. The top
hand twists as the bar is brought around in front of the body and
positioned perpendicular to the ground; the sore hand then takes over,
slowly untwisting the bar by flexing the wrist. “Afterward, you should
be sore,” Tyler says. “That’s how we know it’s effective.”

Eccentric contractions require the muscle to work against a force,
in this case the coiled bar. “You can load a tendon so much more
eccentrically” than with concentric exercises, Tyler says. “So we think
the process may be remodeling the tendon.” Ultrasound studies by other
researchers, including the group in Belgium, have shown that damaged
tendons typically become less thick, indicating they are less damaged,
after a course of strenuous eccentric exercise.

Tyler reported his findings at the July annual meeting of the
American Orthopedic Society for Sports Medicine and has been deluged
ever since with requests from doctors, physical therapists and patients
for more information about how to perform the exercise and where to buy
the bar. (Called the Thera-Band Flexbar, it’s available on Amazon.com;
the manufacturer donated products for the study, but didn’t otherwise
fund it; Tyler is not affiliated with the company.) “It’s not a
difficult exercise but it is unique, so I would advise people to be
taught by a physical therapist, if possible,” Tyler says. If not,
proceed on your own — after, of course, an examination by a doctor;
elbow pain can have many causes, not just tennis elbow. “In my opinion,
you’re not going to hurt yourself,” Tyler continues, although you
should be prepared for a commitment. His patients did three sets of
fifteen repetitions every day. Beginners should start with three sets
of five repetitions, adding more as the repetitions get easier, Tyler
says.